14 years ago a little kitten in a petstore caught my eye. She was a scrawny little thing, all alone and crying in small little cage. I asked the clerk if I could hold her, when I looked down at her she reached for my face and captured my heart. We took her home and named her Bandit.

My little girl has had a rough few past months and I am looking for some advice. Bandit was dx with CRF 3 years ago and was holding her own without any meds until this August. Blood work from August showed that Bandit had hyperthyroid 2.5 mgs of oral methimazole was prescribed and it has been down down hill ever since. Within the 3 weeks Bandit had lost almost 2 pounds and her kidney values increased so off meds she went and subq's began to try and bring her numbers down. In the mean time I noticed her eyes were blood shot all the time and bloody urine. Urine specimen was done came back negative but not cultured as the vet thought initially was it highblood pressure so 1/4 tablet of amlodopine (she has been on this for one week and I have noticed her blood shot eyes are gone but the blood in the urine is still there and she is peeing all over the house). Since Bandit is hard to pill the vet recommended a shot of Convenia®. That did not work so now we are trying Baytril and buprenex injections to ease her pain. Tuesday's visit to the vet now heart murmur and gallop rhythm and a small cyst on her liver making her no longer a candidate for the radio active iodine therapy that I wanted to do all along however the specialist that does it said she had to be on meds first. We are now trying transdermal methimazole 5 mgs which I have given her for the last 4 days and anorexia seems to be returning again as she has refused to eat all day but had a good appetite before we started the cream earlier this week.

It feels like I am running out of options here. I love her so much and want her to be better but nothing seems to be working.

Here are her numbers from last saturday

Bun 53 (ideal per the vet is below 34)
Creatinin 3.1 (ideal per the vet is below 2.3)
Thyroid 5.6 (don't remember what he said ideal was there maybe below 3)
Her last weight was 8.50

Her bp was up to 200 but has come down to 150 with the amlodipine (vet said it also could be down lower at home- stress could throw it off by up to 30 points)

I am worried about what the vet recommended for her Subq's. 150 to 200 mls ever other day in one sessions seems a bit too much for her to handle so today I only gave her 50 ml's in the am and we will see how she feels tonight...I may give her another 50 mls before bed. I also really do not want to give her that cream anymore. :sad:

Any thoughts from anyone?? Sorry so long but I just dont know what to do anymore.

onemeower,I am sorry I cannot answer some of your questions,but I have a 13yr old kitty with Hyperthyroidism,before he was diagnosed,he weighed 16lb,but went down to 12 lb's in no time,although he was eating like a fiend.
He's been on Tapazole 5mg now for more than a year,he gets 2,5 pills daily and is doing good,gained 9oz since his last vet-visit.
Your Bandit though seems to have so many other things going on,we have some very knowledgable cat-gurus on this Forum,just have patience and I am sure they'll help you out,ok.
This weekend is Thanksgiving,maybe people are just busy..

One of our members, growler, will probably be your best source of advice since she has a kitty with CRF, who was also hyperT at one point. I'll pm her a link to this thread, but in the meantime, some questions for you:
What does Bandit normally eat?
Do you know what her urine specific gravity is? What about some of her other lab values, like blood phosphorus and calcium levels?
Is she on any medication for the kidney issues now?

I agree with your decision not to give such a whopping amount of subQs all in one go. Even if you can just do 50ml once or twice a day, that would be way preferable to the 200ml in one session. I'm kind of surprised your vet recommended that for a cat with hbp. As for the heart issues, it's entirely likely that it's related to the hyperthyroid. Is it possible to start her on a lower dose of methimazole? It's frequently the case that vets start cats on too high of a dose. If you haven't checked out the Feline HyperT Yahoo group, I recommend doing so. And there's lots of good info at this site as well: http://www.felineoutreach.org/Educat...hyroidism.html

One of our members, growler, will probably be your best source of advice since she has a kitty with CRF, who was also hyperT at one point. I'll pm her a link to this thread, but in the meantime, some questions for you:
What does Bandit normally eat?
Do you know what her urine specific gravity is? What about some of her other lab values, like blood phosphorus and calcium levels?
Is she on any medication for the kidney issues now?

I agree with your decision not to give such a whopping amount of subQs all in one go. Even if you can just do 50ml once or twice a day, that would be way preferable to the 200ml in one session. I'm kind of surprised your vet recommended that for a cat with hbp. As for the heart issues, it's entirely likely that it's related to the hyperthyroid. Is it possible to start her on a lower dose of methimazole? It's frequently the case that vets start cats on too high of a dose. If you haven't checked out the Feline HyperT Yahoo group, I recommend doing so. And there's lots of good info at this site as well: http://www.felineoutreach.org/Educat...hyroidism.html

Thank you for replying. Bandit was always a fancy feast girl with dry science diet (that the vet recommended). In the last 2 years we switched to Royal Canin dry and the fancy feast. In August the vet recommended a renal maintance diet of Iams or hills neither of which Bandit would touch. Last week I ordered Royal Canin LP pouches that she was scarfing up until we started the thyroid cream now she will not even touch her all time favorite Gerber stage 2 baby food.

Bandit is only on the Subq's for her kidneys- nothing else.

I did ask about her other values and the vet said her phos and calcium were all in the normal ranges and do not recall if he said anything of the urine gravity. I was kind of ticked off that they did not send her sterile specimen to the lab to be cultured for bacteria since that is the reason for her visit (bloody urine). He said there was too much blood in it for them to culture but no protien was in there.

Re the dose of thyroid med he said that 2.5 was the lowest and we started with a half a tablet a day which did nothing so he upped it to the full tablet cut in half and given am and then pm but that was too much.

I also looked through Growlers thread were there is lots of great info, I wish my kitty did not have so many other issues on top of the CRF. I have always tried to take the best care for her and did everything the vet said to do (including annual vaccines which now I regret)

Hi Onemeower, sorry to hear about your Bandit's troubles My grrl Duffy had HyperT that was caught early, it was just a bit higher than normal so no meds were given and was cured w/Radioactive Iodine Therapy. A few years later she developed crf as a result of the Royal Canin toxic food recall. One thing I have not dealt with is HPB, Duffy's has been checked a couple of times and always been the ideal 120.

Have you tried Wellness canned foods? The chicken, turkey, chicken and beef are the lowest phos level food they have and they all have good protein amounts with all healthy ingredients. Low protein theories are outdated and not ideal for cats.

Basically what happens with cats who have kidney failure -diagnosed or not- and HyperT is the HyperT masks the symptoms of kidney failure so it doesn't look as bad as it actually is, and once they are on meds to control the HyperT the kidney values increase - this is not caused by the oral methimazole she was on originally. Increased thyroid hormone levels actually raise the level of blood flow through the kidneys making them more efficient, so when HyperT treament begins it appears that the kidney values get worse. Untreated HyperT however can lead to heart disease incl heart murmurs and high blood pressure, this is a far higher concern than kidney failure.

Approx 15% of cats experience side effects when taking oral methimazole, one of the more common ones is decrease in appetite. When this occurs the cat should be taken off the meds until the condition resolves then restarted at a lower dose which is gradually increase to the level it is prescribed.

Transdermal methimazole has fewer side effects involving the GI tract (vomiting etc) but lack of appetite is also common and when that occurs the meds should be stopped until symptoms resolve and then restart at a lower dose while gradually increasing.

To have the Iodine therapy, they want the thyroid levels to be controlled therefore they need to be on meds (unless the T4 is barely above normal), this also ensures they know about any kidney issues that may have been masked by the high t4 levels.

Please speak to your vet regarding the lack of appetite while on meds. It is difficult enough to get a kidney failure cat to eat, when they are on meds that cause lack of appetite as a side effect that is even worse. A cat that refuses to eat for a prolonged period of time is also at risk of fatty liver disease.

How soon after the Covenia was the baytril and buprenex given? When needed Covenia can be readministered 14 days after the 1st shot to provide longer treatment period.

Some sites say Baytril is contraindicated for cats with kidney disease but has been used for kidney infections and there is a risk of retinal problems including blindness, Buprenex is also contraindicated for cats with kidney disease and those with liver issues as it is metabolized by the liver

I would speak to the vet about using an ACE inhibitor such as benazepril in combination with the amlodipine instead of baytril or buprenex. ACE inhibitors relax the blood vesses making it easier for the heart to pump blood throughout the body reducing hypertension. Proteinuria (protein in the urine) generally is reduced after 2-6 weeks of amlodipine therapy, so it make take some time yet before that is completely cleared up.

Is Bandit meowing while peeing? Or is she peeing tiny tiny amounts frequently? This may indicate pain while peeing and may require pain management therapy - but not something contraindicated for kidney issues.

Generally speaking 150-200 mls of subq fluids every other day is fine, giving less is not doing any good when she is peeing all the fluids she is taking in therefore not retaining as much as she should which only prolongs her dehydration. You can ask your vet about giving 100mls every day instead of 150-200 every other day.

Bandit's kidney numbers are actually not that bad they are right around where my girl was in Aug 2008, however I've never really had any issue getting her to eat .

Do you have a homeopath vet in your area and would you consider taking Bandit there?

My recommendations:
- try different foods like Wellness mention above
- try using cooked chicken breast, cheese, cat treats such as PureBites freeze dried chicken breast as a topper on her food to entice her to eat and if that doesn't work:
- talk to the vet about stopping the transdermal methimazole until her appetite returns then restart at a lower dose, increasing gradually
- talk to the vet about changing to 100 mls subq fluids per day instead of 150-200 every other day
- talk to the vet about adding an ACE inhibitor ie benazepril and discontinuing the baytril and buprenex or changing to another pain management therapy

__________________
Avoid biting when a simple growl will do

The Spirit Lives As Long As Someone Who Lives Remembers You - Navaho Saying

Vindication ~ For all those pets who became sick or lost their lives from tainted pet food

Hi Onemeower, sorry to hear about your Bandit's troubles My grrl Duffy had HyperT that was caught early, it was just a bit higher than normal so no meds were given and was cured w/Radioactive Iodine Therapy. A few years later she developed crf as a result of the Royal Canin toxic food recall. One thing I have not dealt with is HPB, Duffy's has been checked a couple of times and always been the ideal 120.

Have you tried Wellness canned foods? The chicken, turkey, chicken and beef are the lowest phos level food they have and they all have good protein amounts with all healthy ingredients. Low protein theories are outdated and not ideal for cats.

Basically what happens with cats who have kidney failure -diagnosed or not- and HyperT is the HyperT masks the symptoms of kidney failure so it doesn't look as bad as it actually is, and once they are on meds to control the HyperT the kidney values increase - this is not caused by the oral methimazole she was on originally. Increased thyroid hormone levels actually raise the level of blood flow through the kidneys making them more efficient, so when HyperT treament begins it appears that the kidney values get worse. Untreated HyperT however can lead to heart disease incl heart murmurs and high blood pressure, this is a far higher concern than kidney failure.

Approx 15% of cats experience side effects when taking oral methimazole, one of the more common ones is decrease in appetite. When this occurs the cat should be taken off the meds until the condition resolves then restarted at a lower dose which is gradually increase to the level it is prescribed.

Transdermal methimazole has fewer side effects involving the GI tract (vomiting etc) but lack of appetite is also common and when that occurs the meds should be stopped until symptoms resolve and then restart at a lower dose while gradually increasing.

To have the Iodine therapy, they want the thyroid levels to be controlled therefore they need to be on meds (unless the T4 is barely above normal), this also ensures they know about any kidney issues that may have been masked by the high t4 levels.

Please speak to your vet regarding the lack of appetite while on meds. It is difficult enough to get a kidney failure cat to eat, when they are on meds that cause lack of appetite as a side effect that is even worse. A cat that refuses to eat for a prolonged period of time is also at risk of fatty liver disease.

How soon after the Covenia was the baytril and buprenex given? When needed Covenia can be readministered 14 days after the 1st shot to provide longer treatment period.

Burprenex was given a day after the Covenia injection. We actually had to rush to the emergency vet because my girl was hunched over, mouth hanging open and a puddle of urine and blood was there when I picked her up. She had also left little puddles of pee and blood all through the house that day while I was at work. Her little body was so tense it felt like a football she was in so much pain. The ER vet stated her bladder was having spazms and she couldnt control herself. Very frightening. Baytril was given 5 days after injection because we have seen no improvement, we are on day two of it and I see a small difference in the frequency of her using the pan- she is going less.

Baytril is contraindicated for cats with kidney disease, Buprenex is also contraindicated for cats with kidney disease and those with liver issues as it is metabolized by the liver.

I did discuss this with the vet and was told by him that both are a safe med and have helped lots of kitties with CRF. AT this point everything my vets office is doing contradicts what I find out online. I am searching for a new vet but have had no luck so far

I would speak to the vet about using an ACE inhibitor such as benazepril in combination with the amlodipine instead of baytril or buprenex. ACE inhibitors relax the blood vesses making it easier for the heart to pump blood throughout the body reducing hypertension. Proteinuria ({which can include blood as it is a} protein in the urine) generally is reduced after 2-6 weeks of amlodipine therapy, so it make take some time yet before that is completely cleared up.

Is Bandit meowing while peeing? Or is she peeing tiny tiny amounts frequently? This may indicate pain while peeing and may require pain management therapy - but not something contraindicated for kidney issues.

No meowing while peeing, but she is going in and out of the litter pan, leaving little dots of pee stained blood in between some good amount of pee's but they always have blood. She strains alot while in there and is also leaving little puddles of pee with blood all along the base boards, on the throw rugs, and in the bathtub. She will try and make it to the little pan and can not hold it so will pee just outside the pan. Her pee also smells so bad. This is breaking my heart to see her like this:sad:

Generally speaking 150-200 mls of subq fluids every other day is fine, giving less is not doing any good when she is peeing all the fluids she is taking in therefore not retaining as much as she should which only prolongs her dehydration. You can ask your vet about giving 100mls every day instead of 150-200 every other day.

I have spoke to the vet about 100 per day and he disagree's even when I told him she sneezes after I give her 200. I brought up some research I found online from a kidney specialist that is in another site where she says less more often is better than large amounts all at once but still no. These have been his instructions even before the bladder stuff happened.

Bandit's kidney numbers are actually not that bad they are right around where my girl was in Aug 2008, however I've never really had any issue getting her to eat .

The only time I had have issues with her eating is when we have tried the thyroid med- any other time she over eats

Do you have a homeopath vet in your area and would you consider taking Bandit there?

My recommendations:
- try different foods like Wellness mention above
- try using cooked chicken breast, cheese, cat treats such as PureBites freeze dried chicken breast as a topper on her food to entice her to eat and if that doesn't work:
- talk to the vet about stopping the transdermal methimazole until her appetite returns then restart at a lower dose, increasing gradually
- talk to the vet about changing to 100 mls subq fluids per day instead of 150-200 every other day
- talk to the vet about adding an ACE inhibitor ie benazepril and discontinuing the baytril and buprenex or changing to another pain management therapy

Thank you for your response. I answered some of your questions in purple above. I have on my todo list to call the Vet again tomorrow and for tonight I am not going to give her the cream. Unfortunately without the pain med she is not able to handle the pain so I will have to give her that until we find something else. I have used some of the other links you posted above when we started Subq's and they are very helpfull sites As I sit her and type this tears are rolling down my cheeks....I just want my girl to get better.

I will also look into your other suggestions- these days for food she is so picky and wellness was never one she ate before she became ill so I have not tried it again. Today she is not liking anything including her all time favorite people foods but atleast she has not thrown up when I did assist feed earlier today:sad:

Just wanted to point out the changes I made to my post while you were responding including the info about hematuria:

Quote:

Originally Posted by growler

How soon after the Covenia was the baytril and buprenex given? When needed Covenia can be readministered 14 days after the 1st shot to provide longer treatment period.

Some sites say Baytril is contraindicated for cats with kidney disease but has been used for kidney infections and there is a risk of retinal problems including blindness, Buprenex is also contraindicated for cats with kidney disease and those with liver issues as it is metabolized by the liver

I would speak to the vet about using an ACE inhibitor such as benazepril in combination with the amlodipine instead of baytril or buprenex. ACE inhibitors relax the blood vesses making it easier for the heart to pump blood throughout the body reducing hypertension. Proteinuria (protein in the urine) generally is reduced after 2-6 weeks of amlodipine therapy, so it make take some time yet before that is completely cleared up.

Over eating when not on the HyperT meds is a symptom that the condition is not controlled. If she is not eating anything with 5mg I would say IMO she's getting too much at right now and should have it stopped then restarted at a lower dose then increase slowly.

It sounds like Bandit does definately have a urinary infection, I wonder if she has crystals and/or stones too? Did the ER do xrays or an ultrasound?

Did your vet give a reason why he's against doing 100 per day?

Some vets adhere to the thinking that too much fluids when not needed will make the kidneys work harder than they need to, but halving the amount and giving more frequently shouldn't be an issue.

When you give 150-200mls is the fluid completely absorbed within 24 hours?

I would say in light of the issues Bandit is having peeing to go ahead and give 100mls per day

__________________
Avoid biting when a simple growl will do

The Spirit Lives As Long As Someone Who Lives Remembers You - Navaho Saying

Vindication ~ For all those pets who became sick or lost their lives from tainted pet food

Thanks Growler for answering so quickly and sharing so much good knowledge.

Clavamox is a good medicine for my other kitties but for Bandit it gives her severe issues with her stomach both upstairs and down so that is why the Vet suggested the injection first then the Baytril 5 days later. He was hoping the inject would work and so did I since that alone cost almost $50.00. The Baytril seems to be working - there is less bloody urine today (we are on day 3 of it )

Looking at Bandit this morning she seems to be feeling a little better and even ate a little bit of pinnacle and drank on her own this morning I know the pinnalce ocean fish flavor is not the best choice but for now I have to get her to eat something and we will work on moving things over slowly. Poor old girl looks at me with questioning eyes on why so much change all time these days. (I did try and Royal Canin LP pouch this morning but she was not having it )

For the fluids the vet said that Bandit is drinking on her own so she does not need it every day but every other day is good for most cats to start with. He also feels it is too stressfull to do every day so every other is better. I noticed she sneezes, sometimes will sleep for several hours afterwards and it is not absorbed within 24 hours but is gone within the 48. It will travel and settle in her front legs and still be there the day after. I am always careful to inspect her before I give the next session to make sure she is absorbing it. I have lowered the dose on my own to no more than 100 in one session and am checking her skin and mouth and she doesnt appear to be dehydrated.I figure if she needs more later I can give it but giving too much can lead to other problems so better safe than sorry.

The emergency vet did do an Ultra sound everything was good with her bladder (no stones, nothing suspicious) and her kidneys look good for her age and conditions. That is were they found the small liver cyst though but he said they grow over time so she will need a recheck next year to see how it is progressing. When her urine test was done last week there were no crystals and no protein I really wish they would have sent it for culture so that we would know what bacteria we are dealing with though.

Bun 53 (ideal per the vet is below 34)
Creatinin 3.1 (ideal per the vet is below 2.3)
Thyroid 5.6 (don't remember what he said ideal was there maybe below 3)
Her last weight was 8.50

I am worried about what the vet recommended for her Subq's. 150 to 200 mls ever other day in one sessions seems a bit too much for her...

I am sorry to hear about Bandit. These problems can be no fun. Regardless of the heart condition, if the kidney enzymes sharply rise when you start methimazole, then Bandit was not a candidate for I131 anyways. The thyroid medication does not damage the kidney's - the thyroid disease artificially raises filtration which brings the kidney values lower than what they are. Thus sometimes it is striking a balance between the kidney values and signs with the thyroid values and signs. The blood pressure may be secondary to either the thyroid disease or the renal disease or both. Keeping her numbers down not only will save her eyesight but also her kidneys. When her sytemic blood pressure is up, her glomerular (inside the kidneys) goes up and you spill protein into the urine. If you are spilling protein into the urine with kidney failure, the prognosis becomes worse. Amlodipine will help address this. This is a good medication and well tolerated by most cats.

Topical methimazole can work but the absorption is different for each cat. Montoring the values, like your vet is doing, is the best method with methimazole.

As far as values.

Creatinine - a 'ideal' kidney should be at or less than 1.1. According to IRIS (International Renal Interest Society) anything above 1.6 places a cat into Stage 2/4 Renal Disease.

Thyroid T4 should be between 1 and 2. Below 1 is too low. However, in Bandit's case, an 'ideal' thyroid level may not be possible. So I agree with your vet, around or below 3 might be a good place for Bandit.

Phosphorus. This is a value that sometimes gets overlooked. Regardless of the lab's reference range, a cat with kidney disease should not have a phosphorus above 4.5 . As the kidneys start to fail, the phosphorus cannot be excreted and begins to rise. This leads to a variety of serious side effects including hyperparathyroidism (which is directly toxic to the kidney and the cat and can lead the cat to weight loss, loss of appetite, lethargy, etc...) and deadly crystalization of the kidneys and body.

How do we deal with phosphorus rise? 1) a renal diet. These prescription diets are not only neutral balanced, reduced in sodium, balanced in protein, fortified with potassium but they are also reduced in phosphorus. Wet is always better than dry! 2) phosphorus binder. The common one is Aluminum Hydroxide which is inexpensive and effective. However there is recent evidence that aluminum exposure in the face of kidney disease may have some toxicity issues and the medication tastes poorly. Epakitin is my choice as it is a nutraceudical made from shrimp and crab shells. Because of this it is fairly tasty and safe. Here is a link for more information: Epakitin There is a new one called lanthanum which is available. There is a cat form in Europe or a human one in the US but it is expensive.

As far as the SQ fluids. As a general rule I do not recommend more than 100mls at a time. The idea that 200mls once is the same as 100mls twice is not accurate. And in the face of the cardiac and blood pressure issues, I agree with you and I would use less at a time. I would talk to your vet about daily goals of fluid and how to divide them up.

Some additional nutriceudicals.

1) Rubenal. It comes from a medicinal form of rhubarb and has been shown to reduce interstitial nephritis a common type of inflammation and scarring that occurs during chronic renal disease. It has been shown to reduce the inflammation and prolong kidney health. In a taste test most cats will eat it well when mixed with food. No side effects have been seen so far.

2) Azodyl. It is combination of three specific strains of bacteria which will metabolize creatinine, BUN and other nitrogenous wastes. It has been shown to improve patient's appetite and quality of life. It has also been shown to reduce BUN and creatinine levels. There is a wild tiger and lion sanctuary that started using it on their kidney failure rescues. The one was given less than 6 months to live and is 3 years later still active and doing well. Here is a link to my website on Azodyl ( I will have some information on Rubenal coming soon): Azodyl.

When to use these? If your cat has any renal disease, I recommend Rubenal. If the phosphorus is above 4.5 then start Epakitin and if your cat has elevations of BUN and creatinine, then add Azodyl. Ask your vet.

I typically have a rule of 3. Try not to have any more than 3 medications going to a cat at any given time. I do not include the nutraceudicals with this. As we are looking at rhubarb extract, shrimp and crab shell component and harmless bacterial strains (similar to but not a true probiotic) they do not have the variety of issues as other medications.

So if I was to add a third medication to the amlodipine and methimazole regimen I would consider adding pepcid. Renal disease impairs the filtration of gastrin which in turn raises stomach acidity which leads to feelings of nausea. Nausea in a cat is seen as decreased appetite. Pepcid can help. I would ask your veterinarian.

So ask your vet about these. I would follow his or her recommendations on follow up blood and urine testing. I know it gets frustrating to have Bandit poked so much (not to mention the cost) but the follow values help us titrate the medication levels before they lead to more serious consequences.

Almost forgot - thanks for the PM. I also agree with your SQ fluid statement! More is not always better!

Also I did not go into the treatment or evaluation of secondary hyperparathyroidism which may be an issue as well. I would talk to your vet about it. It may be a complicating issue in the reasons why your pet is losing weight. However if the phosphorus is above 6 you may not be able to treat at this point until the level is brought down. So... for another discussion.

When studied in the response to reducing glomerulonephritis and protein loss in the urine, rubenal was shown to have better effects than the ace inhibitor. However when used together they had a synergistic effect and worked very well together. Here is a link for purchasing rubenal at HealthyPets.

I would recommend that the protein loss in the urine be reevaluated after amlodipine and rubenal therapy. If still present, then instituting Benazepril might be a great idea.

I'm so sorry you lost your sweet girl. I lost my kitty to CRF and heart complications earlier this year and I know what you are going through.

Run free, Sweet Bandit

__________________
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"If man could be crossed with the cat, it would improve man but deteriorate the cat." -------Mark Twain
"The animals share with us the privilege of having a soul." -------Pythagoras
"The soul is the same in all living creatures, although the body of each is different." -------Hippocrates